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Biomedical subjects

Aleksandar Janca

Publications and source records attributed to Aleksandar Janca.

16 recordsLinked to original sources
PubMed2007

Posttraumatic stress disorder and terrorism: 5 years after 9/11.

PURPOSE OF REVIEW: This article aims to review and summarize the recent literature investigating the relationship between posttraumatic stress disorder and terrorism. A particular focus is given to the studies related to the terrorist attacks on New York City and Washington, DC on 11 September 2001. The review aims to provide an update on an article published in this journal in the year following the September 11 attacks. RECENT FINDINGS: Elevated rates of posttraumatic stress disorder in the general population follow terrorist attacks but soon normalize, whereas directly exposed populations have higher rates and more persistent symptoms. An increased risk of posttraumatic stress disorder is associated with direct exposure, geographical proximity, female sex, low income, poor education, poor social supports and prior psychotropic drug use, and high-level media reporting of events (for vulnerable individuals). SUMMARY: An accumulating body of data exists on the relationship between posttraumatic stress disorder and terrorism in recent years. Caution needs to be exercised in drawing general conclusions as numerous variables need to be taken into account in addition to the socio-political context of the terrorist attacks. Having said this, a number of consistent findings are emphasized, not least the high degree of psychological resilience demonstrated across populations affected by terrorism.

Adaptation, Psychological↗
PubMed2006

WHO/WFN Survey of neurological services: a worldwide perspective.

According to the findings obtained in the context of a Global Initiative on Neurology and Public Health carried out by the World Health Organization (WHO), there has been a lack of reliable and comparative data on services and other resources for neurological disorders in many parts of the world. In view of these findings and in collaboration with the World Federation of Neurology (WFN), WHO has recently organized an international Survey of Country Resources for Neurological Disorders, which involved 109 countries and covered over 90% of the world's population. This large WHO/WFN collaborative endeavour collected expert information on a number of aspects of neurological care provision around the world including availability of neurological services in primary care; human resources for neurological disorders; sub-specialized neurological services; primary method of financing of neurological care; and disability benefits for patients with neurological disorders. The WHO/WFN Survey results clearly demonstrate that there are inadequate resources for patients with neurological disorders in most parts of the world, and highlight inequalities in the access to neurological care across different populations, and in particular in those living in low-income countries and in developing regions of the world. The key findings of the WHO/WFN Survey including their impact on delivery of neurological care around the world are presented and discussed in this paper. The entire set of WHO/WFN Survey results including numerous tables, graphs and accompanying commentaries can be found in the WHO/WFN Atlas of Country Resources for Neurological Disorders, which is available on request from WHO or at http://www.who.int/mental_health/neurology/ .

Global Health↗
PubMed2006

Towards better understanding and management of somatoform disorders.

Much research has recently been conducted on somatoform disorders demonstrating their clinical importance, associated health-service burden and economic cost. These conditions are often comorbid with other mental and physical disorders and particularly prevalent in primary care and general medical settings. Although culture-specific manifestations and variations of somatization occur--it is now accepted that medically unexplained somatic symptoms are a universal phenomenon. The management of somatoform disorders is generally a complex and lengthy process; however, a number of recent studies have demonstrated the effectiveness of short-term treatments such as cognitive behaviour therapy and educational interventions. Despite advances in their understanding and treatment, debate still surrounds the conceptualization and categorization of somatoform disorders, with a number of experts proposing a complete re-evaluation and reassignment of this diagnostic classification category. The following paper represents a review of recently published literature on frequency, characteristics, conceptualization, impact and management of somatoform disorders.

Cognitive Behavioral Therapy↗
PubMed2006

Mass hysteria revisited.

PURPOSE OF REVIEW: Instances of mass psychogenic response have occurred throughout history, and across population groups; however, the present-day threat of terrorism and biological warfare is expected to enhance societal vulnerability to epidemics of such events. This paper provides a brief review of the current state of knowledge regarding the conceptualization, diagnosis, and management of mass psychogenic response. RECENT FINDINGS: Various terms are nowadays used to denote mass hysteria, such as 'mass psychogenic illness' and 'mass sociogenic illness'. Recent studies investigating personality types predisposed to mass hysteric reactions are inconclusive with a range of results found. Cognitive models of this condition have been effective in promoting empowerment and adaptation among vulnerable individuals. The actions of governments, medical communities, and the media are pivotal in the management of mass hysteria. SUMMARY: The diagnosis of mass hysteria remains contentious, and the mechanisms underlying its perpetuation are similarly ambiguous. The prevalence of 'threat' within the modern sociocultural climate is likely to increase the incidence of the condition, and this could result in serious implications for health services. A holistic approach entailing the collaboration of various public sectors performing a range of preventive activities will be required to contain future mass psychogenic reactions.

Diagnosis, Differential↗
PubMed2005

Pregnancy-induced obsessive compulsive disorder: a case report.

Pregnancy is a well-recognised risk factor in precipitating obsessive-compulsive disorder. We present and discuss a case with the onset of obsessive-compulsive disorder in the fourth month of gestation, which fully recovered two weeks after delivery. The phenomenology of the observed disorder was similar to earlier reports of obsessive-compulsive disorder in pregnancy, i.e. the obsessions and compulsions were predominantly related to the concern of contaminating the foetus resulting in washing compulsions. Despite the initial success with anti-obsessional drugs, the patient stopped the medication in the last month of gestation. Nevertheless, she fully recovered two weeks after the delivery without any psychiatric intervention. There were no obsessive-compulsive symptoms at one-year follow up. The possible mechanisms involved in the aetiology of this case, and future research directions in understanding the role of pregnancy in OCD are discussed.

Journal Article↗
PubMed2005

Rethinking somatoform disorders.

PURPOSE OF REVIEW: From the very moment of their inclusion in contemporary classification systems in psychiatry, the concept of somatization and diagnostic categories of somatoform disorders became a matter of controversy that created an ongoing debate about their validity, reliability and applicability in clinical and research settings. The aim of this review is to provide an insight into the current theoretical, research and clinical dilemmas in the area of somatoform disorders and to illustrate them with brief summaries of scientific papers recently published in this field. RECENT FINDINGS: In the period covered by this review, the most valuable scientific contributions to the current state of knowledge on somatoform disorders were (surprisingly numerous) review papers produced by the leading experts in this field. These comprehensive and critical meta-analyses covered historical, conceptual, epidemiological and cross-cultural aspects of somatoform disorders. Another and a relatively smaller group of recently published papers reported on some novel treatment strategies for patients with specific somatoform disorders, their service utilization and health care-related costs. SUMMARY: If one were to find a common denominator of the papers covered by this review, it is a general agreement amongst their authors that the current concepts of somatization and somatoform disorders have serious theoretical and practical limitations in both research and clinical settings. They suggest that the time has come to seriously rethink these concepts so as to find better nosological solutions for the forthcoming revisions of classification systems in psychiatry and medicine.

Journal Article↗
PubMed2004

Electroconvulsive therapy and determination of cerebral dominance.

Electroconvulsive therapy (ECT) often results in a number of short- and long-time side effects including memory impairment for past and current events, which can last for several months after ECT treatment. It has been suggested that unilateral ECT (uECT) with electrodes placed over the non-dominant (typically right) hemisphere significantly reduces side effects, especially memory disturbances. It is important to note that cerebral dominance equates to speech dominance and avoiding this area of the brain also reduces speech dysfunction after ECT. Traditionally, the routine clinical determination of cerebral dominance has been through the assessment of hand, foot and eye dominance, which is an easy and inexpensive approach that, however, does not ensure accuracy. This review of literature on different methods and techniques for determination of cerebral dominance and provides evidence that functional transcranial Doppler sonography (fTCD) represents a valid and safe alternative to invasive techniques for identifying speech lateralisation. It can be concluded that fTCD, notwithstanding its costs, could be used as a standard procedure prior to uECT treatment to determine cerebral dominance, thereby further reducing cognitive side-effects of ECT and possibly making it more acceptable to both patients and clinicians.

Journal Article↗
PubMed2004

Can physical activity improve the mental health of older adults?

The world population is aging rapidly. Whilst this dramatic demographic change is a desirable and welcome phenomenon, particularly in view of people's increasing longevity, it's social, financial and health consequences can not be ignored. In addition to an increase of many age related physical illnesses, this demographic change will also lead to an increase of a number of mental health problems in older adults and in particular of dementia and depression. Therefore, any health promotion approach that could facilitate introduction of effective primary, secondary and even tertiary prevention strategies in old age psychiatry would be of significant importance. This paper explores physical activity as one of possible health promotion strategies and evaluates the existing evidence that supports its positive effect on cognitive impairment and depression in later life.

Journal Article↗
PubMed2002

Parkinson's disease from WHO perspective and a public health point of view.

The World Health Organisation (WHO) occupies a unique position in the area of health care and represents a neutral platform that can be used to bring about international collaboration in research. International projects carried out by WHO follow public health principles and are devoted to problems and diseases that are frequent, cause severe disability and represent a significant burden on communities and societies all over the world. One of such projects is the WHO Global Initiative on Neurology and Public Health, which aims to increase public and professional awareness of the prevalence, severity and costs of neurological disorders as well as of the possibilities for their prevention. In the context of this Global Initiative and in order to raise awareness of the public health importance of Parkinson's disease, WHO has established a WHO Working Group on Parkinson's disease. The recommendations produced by this Working Group have guided WHO's work on public health aspects of Parkinson's disease including epidemiology, organisation of services and treatment, education, training and information, and direct and indirect costs of care.

Data Collection↗
PubMed2002

Outcome measurement in rural mental health care: a field trial of rooming-in models.

The main objectives of this project, in rural Western Australia, were to collect information, compare and evaluate the functioning of novel types of psychiatric services, including rooming-in facilities, using outcome measurement tools, and to assess the attitude of mental health professionals towards routine outcome measurement. For the first time in rural health services, two outcome measurement tools were used for this purpose: the Health of the Nation Outcome Scales and the World Health Organization Short Disability Assessment Schedule. While staff at 11 rural sites were trained in the use of outcome measurements, only staff from three sites were able to participate in the data collection that spanned for a year and shed information on 39 patients. Two of these sites were rooming-in facilities with different models of care and patient characteristics. Shortage of staff, lack of adequate local information technology support on sites and technical difficulties limited participation. The assessment of staff attitudes towards routine outcome measurement revealed a need to provide staff with reasons and incentives for incorporating outcome measurement into routine practice, in addition to provision of a thorough and on-going training and support in time and resources from management.

Adult↗